Effectiveness of transcutaneous electrical nerve stimulation (TENS) units for headache treatment in a United States population

Editor’s note: The research described below comes from a recipient of a 2026 MSC Travel Grant supporting travel to the 68th Annual Scientific Meeting of the American Headache Society. These grants reimburse travel expenses for those who have had their abstract for a presentation or poster accepted at a meeting. 

By Agatha Greenway, PhD student, University of Iowa.

What is the research gap that your study addresses?

The transcutaneous electrical nerve stimulation (TENS) unit offers versatility, affordability, and accessibility for acute and chronic pain management. We asked whether the TENS unit is a suitable alternative to migraine-specific neuromodulation devices for migraine treatment at a lower, more affordable price.

What is your research hypothesis?

Use of a TENS unit in a United States adult population that experiences headache will reduce headache frequency and/or severity.

What methodology did you use to address your research hypothesis?

We conducted a cross-sectional questionnaire-based study, approved by the University of Iowa (UI) Institutional Review Board (IRB # 202409670). Between April 2025 – January 2026, posters with QR code access to the 22-question survey were left in the waiting rooms of several UI health care locations. A mass email detailing the study and the eligibility criteria was sent to the UI community as an additional method of subject recruitment. The inclusion criteria were people aged 18-89 who experience headache and possess a TENS unit.

The participants’ responses were anonymously collected through a REDCap database at the University of Iowa. Diagnostic criteria were applied to the survey responses to distinguish between migraine with and without visual aura, and other headaches based on the ICHD3 classification.

Data collected in this study included headache improvement in frequency and/or severity and satisfaction with TENS use for headache. Other data collected included gender; laterality of headache; headache sensation, headache severity, effect of walking on headache symptoms, headache duration, personal history of motion/car sickness, family history of migraine or headaches and motion/car sickness, TENS use, headache medication since using TENS, prior headache medications tried without benefit, and side-effects from TENS use.

What are the main results of your study?

Of 103 responses, 68 fulfilled the inclusion criteria. Respondent headache descriptions were classified as likely migraine (n = 58) or other (n = 10) using ICHD3. Overall, 39% of responses reported that TENS use improved headache frequency and/or severity (41% migraine). Younger patients reported headache improvement (1-year OR 0.93, p = 0.010) and satisfaction (1-year OR 0.94, p = 0.019) more frequently than older patients. 70% of respondents were at least somewhat satisfied with TENS use for headache (73% migraine). No other clinical or demographic factors were significantly associated with improvement or satisfaction. Minimal adverse events were reported.

What conclusions did you reach based on your results?

TENS units may offer a safe potential treatment option for patients with headache, including migraine. The high global rate of satisfaction, consistent with existing literature on migraine-specific neuromodulation devices, suggests TENS may offer a more affordable alternative.

What are the limitations of your study?

Our study lacked a standardized protocol for participant usage of the TENS device. For future studies, we would encourage study design to include these parameters and ensure compliance. We also lack a sham or no-stimulation control group to compare results to, which would further strengthen the findings of this study. Additionally, we used ICHD3 criteria to determine whether participants had migraine based on their survey responses. 83% of the participants we classified as migraine reported that they have received a migraine diagnosis. Two participants classified into the other headache group reported they had also received a migraine diagnosis.

What is the relevance of your study to migraine?

Current migraine-specific neuromodulation devices have mixed insurance coverage that is not guaranteed, making them inaccessible for some patients. The TENS unit offers a more accessible and affordable option. Our study suggests that TENS units may offer a safe potential treatment option for patients with headache, including migraine. We hope that these results will warrant future prospective studies and clinical trials investigating TENS use in the treatment of headache disorders.